Provider Demographics
NPI:1821709494
Name:PETERS, SETH TIMOTHY
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:TIMOTHY
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1611
Mailing Address - Country:US
Mailing Address - Phone:413-540-1234
Mailing Address - Fax:413-534-2889
Practice Address - Street 1:152 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1611
Practice Address - Country:US
Practice Address - Phone:413-540-1234
Practice Address - Fax:413-534-2889
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN63083164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse